HomeMy WebLinkAboutDrain Layers Permit 46 Hollis Road L TOWN OF SOUTH WI N DSOR w
DEPARTMENT OF POLLUTION CONTROL gip No.:
South Windsor, Connecticut S;�`���
List No.: _
DRAIN LAYER'S PERMIT Np 789
, 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at /. �jj e�g C �--a z o on the
side, between
at premises owned b
•i:e C i L f�'cJs;:�J
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
S"ANIITARY SEWAGE ( ), INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire on 19"
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit and the reverse sire
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
Signed '
Connection Charge Paid Licensed Drain Layer
Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL -'✓ (Sig)
FINAL (Sig)
APPROVED ,f 4 ,f (Date)
A , R.�� (Sig)
INSPECTOR